Healing Combat Trauma

Rob Honzell's First Person Account, as a Vietnam Vet, of Combat PTSD

An update on an earlier blog post, from February of this year.  Rob Honzell, Sr., M.S.'s book, First Person: Combat PTSD, is now available at Amazon.com.  It's Honzell's account, in his own words, of what his Vietnam experience was like, and how they've affected the ensuing years since.  Not sure how much of it relates specifically to PTSD, despite the title -- I've just started leafing through it -- but to the extent that it's written by a Vietnam veteran who's been coming to terms with what he experienced ever since, it's worth knowing it's out there, and maybe seeing if your local library will buy a copy, to keep the Vietnam experience alive so we can keep learning from it.

It's also fair to say, not many people are able to write about their own experiences with PTSD - it's just too devastating.  We mentioned the other day a book that's just come out by an Army Ranger, Nate Self, about his Two Wars: with insurgents and with his own PTSD -- from the current OIF/OEF conflict.  With hundreds of books about the wars in our collective lifetimes, the just aren't many that address this topic directly, by people who've experienced PTSD.  Let's hope these are the start of many more contributions to the first person narrative literature on the subject.

SSgt. Travis Twiggs - Well-Loved U.S. Marine and Hurting PTSD Hero - the Update

It's nice to know that the exceptionally tragic story of PSTD sufferer and well-loved Marine SSgt. Travis N. Twiggs hasn't completely faded from view -- a story we broke here, days before the national media even picked it up.  This weekend it looks like the Times-Picayune has a two-part series about Twiggs on the NOLA.com website, linked here, and the story is both well-written, and contains - gasp - actual reporting, including conversations with the dad and stepmom, both Louisiana residents.  (The Twiggs brothers spent their formative years in Ama, Louisiana.)  It's a shock to me that CNN never covered the Twiggs story -- although they did cover the story of the Marine on leave who was murdered over $8 in his pocket.  I guess the fear-mongering, anxiety-producing shock value of that "news," while terrifically sad in itself, beats the prospect of actually covering a story with some complexity and depth, in which we as Americans could stand to learn more about the life and background of an American hero whose death we mourn.  Weird values, CNN (or maybe complete lack of them...)

One nice development since our original reporting on this story, back in mid-May when it happened.  The Marine Corps Gazette, which originally published Travis Twiggs' story about his battle with PTSD, put the article back in print.  It's available on their website now, linked here.  And they added a nice little blurb about mourning his passing and extending their condolences to his family, which is appropriate.  It also sounds like there was a Memorial Service for the extremely well-loved Staff Sergeant at Quantico a week ago, which allowed his fellow Marines and those he'd come in contact with over the years, to pay their respects.  Also a very nice, and well-deserved touch.  (So much better than just sweeping the whole situation under the rug, because it had such a tragic ending.)

Other nice developments include hearing more from Travis Twiggs' wife, Kellee, about her husband's ongoing and difficult battle with PTSD.  We've blogged about her here and here, and those entrees are well worth reading, to learn more about the spouse and family's battle with PTSD, since it ultimately involves them very much.  Kellee is an impressive American hero herself, and their two lovely girls will now grow up without their dad -- and with undoubtedly many questions about why he had to die -- because of this terrible opponent he faced, which ultimately defeated him.  (And don't think they won't struggle with that: research has shown that PTSD does have consequences into future generations.  We've blogged about that elsewhere here.)

It turns out that Kellee Twiggs and Travis Twiggs went way back, and had known each other since childhood, though married for the last decade. In other words, a wife who really knew her husband, and what was, or wasn't, normal for him to be like, behavior-wise.  I still remember some of her first words from a tv report, on learning of her husband's violent death in Arizona.  It's from an audio clip, and she's obviously upset, and her words at the end just trail off, like she's debating about whether she can even say what she's wanting to say. The quote?  "He was sick, mentally. with PTSD. and this is the result of it.  He now leaves me, and two beautiful daughters, because NOBODY in the Marine Corps, here at Quantico, wanted to take the time..." To do what?  Here's where it gets so difficult...

To listen? PTSD sufferers often don't want to talk about what they're really going through.  A note from someone who was undergoing treatment with Travis at Bethesda let me know that as great a guy as Travis was, and he really WAS, his friend emphasized, he definitely didn't want to talk about his down times.  To treat it?  Sounds like Travis Twiggs had gone through multiple forms of treatment for his PTSD, but none of them were effective -- and that's pretty par for the course, in some ways.  The current thinking seems to be, hand someone a handful of pills -- at one time, Travis was taking 19 different medications -- and hope for the best.  There was some counseling involved, but it sounds like very little -- and the whole emphasis of the medication is on "forgetting" or "blurring out" (numbing out) the memories -- so when you're on the medication you're pretty much a zombie (his wife speaks of his being -- great made-up word -- in "comatose-dom" while he was on medication), and when you're off, why, the memories of what you're trying to forget just come flooding back.  Intrusive memories (meaning, you get them when you don't want them) are a hallmark of PTSD.

And Twiggs had some memories he was very much trying to forget.  Not things that he was at fault for, per se -- but things that troubled him at the deepest possible level, and for which he felt some, perhaps unfounded, responsibility.  His loss of "two of his boys" --  Lance Cpl. Robert F. Eckfield, Jr., 23, from Cleveland, Ohio, and Lance Cpl. Jared J. Kremm, 24, of Hauppauge, N.Y., who died on October 27, 2005 from an "indirect fire explosion'' in Saqlawiyah, Iraq. (Kremm died at the scene of the explosion, and Eckfield died of injuries later at a battlefield medical center where he was evacuated.)  Twiggs felt, whether accurately and wisely, or not -- the burden of their deaths -- as a form of guilt he never overcame.  And here's where I wonder whether the Marine Corps' heavy emphasis on never leaving a brother behind, while laudable, can also be overdone a bit -- to the point that someone with a sensitive conscience -- for lack of any better way to describe it -- can't manage the pain afterwards of realizing some died on his watch.  "Everything in balance," the Taoists used to say -- and that includes troubling, painful emotions like grief.  In a heartbreaking, terrible situation like this, you can perhaps see why.

I've been reading Raymond Scurfield, DSW lately -- in particular, A Vietnam Trilogy: Veterans and Post-Traumatic Stress: 1968, 1989, 2000 -- and some things really never change, including the nature of combat, and its affects on those who suffer its obvious trauma.  (Scurfield, a social work professor, worked for years with the VA on PTSD, and started his career as a social work medic in Vietnam.)  At the very beginning of his book, he talks about meeting a (deranged) Marine, who'd had a serious psychotic breakdown in Vietnam.  In moments of lucidity, this Marine would plead, in absolute anguish, for Scurfield to help him get back to Vietnam to rescue his buddies -- buddies he had left behind.  But this Marine, unlike Twiggs, had deserted his guys -- or at least believed that he had.  Desertion in the actual military sense of the word.  Not so, Twiggs.  The Vietnam-era Marine cried out to Scurfield the social worker, "I have got to get back!  I let my fellow Marines down terribly [when he broke down and was medically evacuated.]  I have to go back -- to prove that I am a man!  Can you help me, to get back?"  Even 40 years later, you can still hear the anguish of that man's cries.  AND his confusion over whether he'd actually deserted his men, by getting so sick that he had to leave.  Scurfield writes about what a tortured experience that was to go through, because he knew that the man of course was never going to be able to get back, in his present condition, and would likely be broken by the guilt he felt about the matter.  "He could never make right," Scurfield writes, "What I later came to understand, is perhaps the most unforgiveable and egregious shame that can befall any combat soldier -- 'deserting' or otherwise letting down one's buddies in the heat of battle."  ("The image of this tormented soldier stays with me still," Scurfield concludes.)

Of course, Twiggs wasn't guilty of deserting his buddies in battle -- they died because they were attacked, and he was powerless to prevent their death.  But that wasn't the way he looked at it, apparently -- and an additional "head trip," that probably only added to this -- was the event Twiggs talks about in his PTSD essay, where unbeknownst to him, some of the first people he met upon hitting the ground at the homecoming ceremony for his battalion, just back from Iraq -- were the FAMILIES of those two men, who he apparently was not expecting to see.  Apparently seeing them in the midst of an otherwise mutedly joyful occasion just further seared into Twiggs' mind that the reason those guys weren't here with the rest of them was somehow, inexplicably, his fault.

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I do think this is where the Marine Corps needs to bear some responsibility, unless it already does, for right training on the matter - again, a matter of "balance."  OF COURSE you want to do everything in your power, from boot camp all the way through repeated deployments -- to keep your buddies alive and as safe from harm as you can make them -- but the important points are, taking responsibilty for only what's within your power to have happen (disregarding fate), and, realizing that beyond obviously, we're talking combat here, and people are gonna die.  It seems like both sides of that coin -- care for your brothers, and understanding that not everyone comes back alive -- are equally important, and maybe only philosophical, sophisticated thinkers can balance both sides of that concept at the same time.  I'm not making fun here, a favorite Marine officer who was grievously wounded in Iraq once told me that he thought the ability to balance two contradictions in your mind at once, without denigrating the importance of either, was high intelligence indeed.

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I know that the Marine Corps includes Sun Tzu's famous Chinese classic on the art of military strategy, The Art of War, in its Commandant's reading list -- that every Marine reads through, appropriate to his or her grade -- but it might be a good idea to broaden the exposure to what other Taoists think, since they're such admirable realists about the dual nature of life.  (Curiously, Taoism is such a non-possessive school of thought that someone can be a practicing Catholic, Unitarian, Wiccan, or no religion at all, and not find a conflict of religious "allegiance".)  Here's what one latter-day Taoist philosopher and poet had to say about the compulsive nature of intrusive thoughts and worry, and it relates directly to what Travis Twiggs and others underdo all the time, in combat and its aftermath.  "Worry is an addiction that interferes with compassion," writes Deng Ming Dao in 365 Tao, and continues, "Worry is a problem that seems to be rampant.  ... Whatever the source, it is clear that worry is not useful.  It is a cancer of the emotions -- concern gone compulsive.  It eats away at body and mind."

"It does no good to say," he continues, "'Don't think about it'."  You'll only worry more.  It is far better to keep walking your path, changing what you can.  The rest must be dissolved ... In this world of infants with immune deficiencies, economic imbalance, personal violence, and international conflict, it is impossible to address everyone's concerns.  Taking care of yourself and doing something good for those whom you meet [and serve with?!] is enough.  That is compassion, and we must exercise it even in the face of overwhelming odds [combat?!].  Whenever you meet a problem, help if it is in your power to do so.  After you have acted, withdraw and be unconcerned about it..."  (Not to belabor the obvious, but not "unconcerned" in the sense of "we don't care," unconcerned in the sense that, we've already done what we can, and let's not continue to ruin more lives in the process, with needless worry...)

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Back to Ray Scurfield, for a moment.  Isolation is a hallmark of PTSD, because of the very real risks that NOT isolating yourself from others, in combat, creates.  Unfortunately, it's hard to turn this skill "on" and "off" like a light switch.  But in combat, you bond heavily with others at your (eventual) peril.  It's possible that SSgt. Travis Twiggs, well-loved by his Marines and his family, just didn't "get" this, and it's part of what eventually killed him, when he broke under the strain of his perhaps misplaced guilt and PTSD.  Writes Scurfield, "Indeed, the bonds formed during war can be so powerful that men become closer than brothers.  Unfortunately, this is a two-edged sword.  Brothers-in-arms protect each other, look out for each other, help to get each through the war." "On the other hand," he continues," if something happens to your close buddy, it can be devastating.  Many vets talk about how, at some point during their war tour, they suffered the tragic loss of someone whom they had let themselves get close to; the impact is profound."

Scurfield includes a story from a suffering Vietnam vet who did just that, to drive home his point.  Scurfield retells the story in the man's own words: "I had been warned by some of the seasoned vets not to let other people get close to you -- "because it hurts too much if something happens to them."  In spite of my better judgment, I did get close, real close [to another veteran, during combat] ... [He] and I got closer than I have been with anyone before or since; we became as close as any two people could possibly be."  And, after [his buddy] got killed, I hurt so bad...And I knew right then, I was never going to let anyone get close to me again.  And I didn't. I looked out for number one. Period."

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"A great guy, a horrible tragedy"

Travis Twiggs, who from all accounts was a very big-hearted, loving guy, apparently never did close himself off like the Vietnam vet in Scurfield's account did.  If you know anyone who knows Travis Twiggs, you know that he was a well-loved guy.  His Marines loved him, his wife loved him, his family loved him -- heck even his landlord loved him, and people he'd just barely met -- even when his PSTD was full-blown.  And if that isn't a testament to what kind of guy he was, I don't know what is.  (His landlord in Virginia, "Mr. Bob," as his Twiggs' wife, Kellee, sweetly calls him, the head of a famous international philanthropic organization in the D.C. area, basically broke all land-speed records trying to get the word out, after Twiggs' death, that he was being mischaracterized in the media as a violent criminal, when in fact he was the sweetest and warmest guy imaginable, who literaly would do anything for anybody.  Many who knew Twiggs seemed to feel the same way.)

One of the true delights of having broken this story early was hearing in emails from people who did know Travis, and let's just say for the record -- it was all good.  Here's one of the best ones I received, though, from a professional guy in Washington, D.C., who spent some time in the same ward at Bethesda as Travis Twiggs did, back in March of this year (the same time period where I was trying to get in touch with him, and getting worried about what his silence actually meant.)  Here's what this guy had to say:

"In the two weeks I was there as a patient, I got a chance to know Travis. Travis was a great guy, he had a heart of gold and would befriend anyone. The staff loved him - he had been there the longest (two months). While I was there, I had a few conversations with him - mostly about what his current duty was and his plans for discharge. While he was a outwardly friendly guy, it was clear he was also in a great deal of pain (I never asked him the details of his PTSD - one learns quickly that those are depressed (like me) can talk more openly than those who have PTSD - who typically are reluctant to open up). So, I did not know the extent of his pain, just that he was in alot of pain. When he was in pain, he tended to withdraw. When not in pain, he was quite lively and was always the center of attention. I think he really wanted to get better and heal, but just got caught in a bad situation and did not reach out to those who could have helped. I don't know anymore beyond what I have been told and what I have read. Like I said, he was a great guy and this is a horrible tragedy.

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I know I spent quite a bit of angst in March wondering what had happened to Travis Twiggs, well before his untimely end, and hoping I could get in touch with him -- both to see how he was really doing (I had my doubts), and to see if I could republish his original article from the Marine Corps Gazette, in full -- because I believed it could greatly help other veterans who were suffering.  I got an email back from him -- an autoreply -- mentioning another email address of his, referencing "War Pig."  It made me curious just what was behind this "War Pig" reference -- was his battalion nicknamed that, like Eric Acevedo's had been nicknamed, War Dogs?  (It wasn't.)  Did it have to do with some fondness for Light Armored Vehicles?  (Also nicknamed War Pigs.)  That seems a bit much, even for a Marine :-)  (No, it turns out it wasn't.)  Or did it maybe have to do with some lyrics from an old "Black Sabbath" song called War Pigs, which Twiggs was himself old enough to remember?  But those are pretty anti- at least the insanity of war, pretty un-likely for a guy who'd been a career active duty Marine.  (Twiggs was such a gung-ho Marine that, on top of his five deployments(!), he'd actually left the Marine Corps at one point -- and come back!)

It turns out there's a much better story to what "War Pig" signifies, told by a Twiggs family member.  Apparently when Twiggs served in Cuba, he was up so many days straight being a Marine, doing his duty, that when he finally got to sleep, he slept for literally days.  So long, in fact, that a commanding officer wrote a sign and stuck it over his sleeping form, "Here lies the War Pig."  Indeed.

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It's heartbreaking that Travis Twiggs, straight-ahead U.S. Marine, loving father, husband, son and brother, leader of Marines, hospitable neighbor, friend of many, including those he'd barely met -- lost his painful, deeply personal struggle with PTSD.  It's especially heartbreaking to think of how much of the trouble he suffered seemed to revolve around the loss of his guys -- a loss he would have been powerless to prevent, and for which he had suffered, and grieved, already enough.  The rending cruelty of PTSD is that by his own dying, not only did he not take the pain of his Marines' losses away, but he also actually added to it, with his own.  Now his Marines grieve, but also his family grieves, and everyone has to go forward without him, who was heavily there for others, but ultimately couldn't be so for himself.

There are a lot of lessons from Travis Twiggs' needless death from PTSD, and I don't think we're in any position to realize all of them, yet.  Or to attend to them, and "fix" their consequences, so things like this don't happen anymore.  We're sadly still a long way off from that.  One "clue" in all this was left by Travis himself: that a handful of medications doesn't really work to solve the problem, if the underlying felt problem is guilt.  All the medications do -- besides complicate matters -- is keep the patient numbed out, but not capable of working through his very real torment.  Take away the medications, some of which are probably vital, but not all -- and the torment is right where it was before, more or less unchanged.  More needs to be done to uncover the roots of PTSD -- who gets it, and why, and most of all, how to treat it, successfully -- but whatever ends up being the "magic bullet" will undoubtedly be a combination of things: medication, talk therapy, and even the seemingly far-fetched (see our recent series on Complementary and Alternative Medicine and PTSD).  It would be pretty Taoist to say, whatever ends up helping, let's use it, because what we care about is not what type of solution it is, but how much it helps those who are suffering, in the throes of it.  We can already tell what doesn't work, which is pretty much the status quo: a handful of medications to mix (against the rules) with drugs and alcohol, combat veterans' frequent and very understable choice.

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At the risk of oversimplifying things, what's killing veterans with PTSD is what they can't forget, and what they feel somehow responsible for seeing, doing, experiencing -- or not, in some cases.  It's this responsibilty that may be ultimately wrongly placed.  As combatants, they're just doing the best they can, under the circumstances.  In war, more so than any other situation on earth, it's pretty clear that sh*t happens, and that's hard enough to deal with, without going away thinking for years that it's your fault.  Maybe it's time to cut back a little on the gung-ho warrior's creed of never leaving a brother on any level, because it's messing with people's heads when they ultimately have to, through no fault of their own.  Couldn't at least some sort of balance be taught?  You want to give your all for your brothers (and sisters), but when stuff happens, and you can't, you've done things to the best of your abilty, and maybe you can let it go -- let IT go, not THEIR memories.  Again, a powerfully difficult concept to live -- but nevertheless, an equally powerfully freeing one. "Right thinking" needs to become part of right warfare -- because the casualties of not having that are starting to become really obvious.  Far more young guys (and women, but mainly guys) kill themselves as combat veterans when they just can't take it anymore -- it's much less common when older guys do.  At 36, Twiggs was older than many Marines he served with.  Undoubtedly, he felt that only added to his responsibilty.  But even this week, there are stories in the news about older OIF/OEF veterans who have killed themselves from PTSD -- one is an Army major in the Midwest, who was about to get orders to go back. 

So the horrible finale of PTSD -- suicide -- while primarily a young servicemember's act, is by no means limited to them.  (We're in the midst of blogging about this topic; look for more on this, later.)  We're also dealing with an all-volunteer military that has an average age that is strikingly quite young.  The one career Marine I know who's been deployed almost as many times as Twiggs was, but did get help for his PTSD -- did it because he knew that without it, he was affecting his family too much.  Extremely commendable.  He got the help, and stayed a Marine.  And he's still alive today.  Twiggs, whose case may have been worse, tried some to get help, and couldn't get past what was killing him, despite his love for his family, and his Marines.  It's a sad, sad tale that ends this way, with the crushing feeling that it really didn't have to, but how?!!  I'm glad that more all-encompassing coverage is finally being given to who Travis Twiggs was, not just how he died -- but I can't help thinking about his death, and how, "Here Lies the War Pig," finally getting his rest, at last, is at least as fitting a tribute, as any.

More Combat = More Trauma, and More Chance of Developing PTSD, Study Shows

For anyone who's every wondered about whether troops' increased exposure to combat trauma results in greater chances of their developing PTSD, the answer is a definite "yes," according to a study released in the February issue of the Psychiatric Times, linked here.  The article from which excellent graphic (left) is taken is entitled, "Posttraumatic Stress Disorder in Veterans," and it makes the point that cumulative exposure to combat trauma predicts PTSD in a linear fashion.  Less exposure (fewer firefights) -- lower rates of PTSD; higher exposure (greater number of firefights) -- higher rates of PTSD.  According to the article, it really is that simple.

The article's authors cite an earlier published report of OIF (Iraq) and OEF (Afghanistan) servicemembers, and found high rates of exposure to both "traumatic situations and combat."  "According to the study, about 33% of soldiers in Afghanistan and 71% to 86% of soldiers in Iraq experienced a firefight. PTSD rates ranged from 6.2% for veterans of Afghanistan's OEF to more than 12% for OIF veterans. The risk of PTSD was found to increase linearly with the number of firefights (see graphic, above). Having been wounded, a condition previously found to be predictive of PTSD, was also significantly associated with PTSD. As is commonly found in patients with PTSD, rates of depression and alcohol use also increased following combat exposure."

When we think of tragic stories of what we can only assume to be PTSD-fueled incidents in the news -- the recent suicide of Marine SSgt. Travis Twiggs, the arrest of Marine LCpl. Eric Acevedo for murder, and others like them -- we should really stop to pause and wonder, how many times have these servicemembers been deployed, for how long have they been in combat, and to what have they been exposed (meaning, how many firefights)?  Twiggs, it turns out, had done four(!) tours of Iraq, and one of Afghanistan (earlier reports mentioned four total, but they were wrong); Acevedo had done three tours of Iraq by the time he was 22, including one that involved a horrific battle, where 10 members of his battalion died on a single day, and several others were wounded.  To not take the effects of their cumulative exposure -- what they saw, did, were witness to -- is just unconscionable.  We have a very love-hate relationship with the glory of serving in this country: we glorify our military heroes for their astounding feats of endurance (Brad Kasal, the Marlboro Marine, etc.), but we also equally unreasonably vilify them when they crack under the all-too-obvious strain.  It seems like what we need most of all is just the sober estimation: the more servicemembers have gone through -- and suffered -- the more we can expect them to have problems later on, with developing PTSD.  As noted Australian Vietnam War researcher Hedley Peach said in a slightly different context, what we're really looking at here is not something unusual -- it's the generic effect of combat.

Army's PTSD Cases Double Over Last Year; Marines Close Behind

An article in yesterday's Washington Post, linked here, reports that diagnosed cases of PTSD in the U.S. Army have more or less doubled over last year, with the Marine Corps also increasing numbers significantly.  The Navy and the Air Force are reporting fewer cases; which either means that they're not seeing as much action or they're lagging in understanding how to report cases; or a combination of both.  It's no surprise to anyone who's been following veterans affairs that the Army, the Marine Corps, and the National Guard have been stretched to the maximum with overlong deployments, back-to-back deployments, and less than fully-adequate attention to the psychological wellbeing on the troops. Let's hope these and future statistics mean something to decision-makers who can make a difference to veterans who have given so much already.

More Camp Pendleton Marines Died Non-Combat Deaths Than Died in Iraq Last Week, Marines Admit

Here's a troubling story, where the above headline basically says it all.  An article by Rick Rogers from last Friday's issue of the San Diego Union-Tribune, entitled "Marines hit by rash of non-combat fatalities," and linked here -- has this stunning factoid tucked away, several paragraphs into the story:

At least 13 Marines from the 1st MEF – most of them stationed at Camp Pendleton – have died this year. Most of the causes are believed to have been vehicle crashes, homicides and suicides, although some cases are still being investigated.

By comparison, six Camp Pendleton-based Marines have died from combat in Iraq during the same time period, according to the Defense Department.

The reporter also notes, "None of the Marine officials interviewed for this story could remember a worse week in terms of noncombat losses."  So sad.

It's important to note that sometimes reckless driving is "just" that, and sometimes it's a form of vehicular suicide, whether fueled by alcohol and/or drugs, including prescription medications, whether mixed with alcohol or not.  (Much like "suicide by cop" has become something other than a random altercation with police.)  The Marines, faced with an increase in motorcycle fatalities, are taking pains to educate the troops more about the risks involved -- risks which are probably fairly well understood, though not necessarily attended to.  Heartbreaking news from Southern California, in any case -- for all the Marines, and their families, not to mention those who've served with them.

Travis Twiggs' Widow, Kellee, Puts a Human Face on the Suffering of PTSD

I come away just so impressed with Kellee Twiggs, the grieving, sympathetic widow of the late USMC Staff Sergeant Travis Twiggs, who passed away recently, one might say, from PTSD complications, after a long and difficult battle with that powerful adversary.  Kellee was as much in the dark about the events immediately leading up to Twiggs' suicide as anyone else watching this painful scenario unfold; but she was and is very clear on the ravages PTSD took on her wonderful husband, who she dearly loved.  There's been a great raw video interview footage on the Web for the last few days of Arizona tv reporter, Suzanne Kennedy, interviewing Kellee Twiggs about PTSD and her husband, Travis.  Because it's unclear how long that video will stay on the Web, and also because so much of the Twiggs' story is worth knowing, I took the time to create a transcript of the interview, a downloadable copy of which is available here, Download transcript_of_kellee_twiggs_interview.pdf.

In the interview, Kellee Twiggs, who I very much hope has a future as a patient advocate, given what she's gone through, and how personally she knows the ravages of PTSD in a combat veteran's life, comes across very well -- as a kind, sympathetic, reasonable person, who ultimately feels that the Marine Corps did not do enough to save her husband's life (and that the current courses of treatment for PTSD -- at least the ones Travis was exposed to, with their emphasis on locked wards and overmedication with a slew of pharmaceuticals -- aren't the most effective treatments possible.  From her vantage point, they were tried with her husband, and they just didn't work.  Is her point of view that of a treatment professional?  No.  But it's very much as someone who loved her husband, and cared what he was going through -- and ultimately saw the system fail.  One of the most interesting parts of the video to me was how she isolated the need to address the guilt that her husband felt, and was apparently unable to overcome, from letting others down.  It's a very interesting video interview.  Watch the entire clip, here; or read the transcript, linked above.  And keep the Twiggs family in your thoughts and prayers this Memorial Day and after.  It's hard enough to be a military family with a deployed servicemember.  It's even harder to be a military family grieving a terrible, combat-related loss, as the Twiggs are presently.

Twiggs' Wife: "The PTSD Drove Him Crazy"

Wow...well, for a truly excellent experience, see this raw footage by Arizona TV reporter Suzanne Kennedy, interviewing SSgt. Travis Twiggs' wife, Kellee.  It's great stuff.  Kellee Twiggs speaks her mind, the reporter asks fairly good questions and leaves Kellee plenty of room to talk, and it's long -- which means you get quite an opportunity to hear from Kellee about what Travis Twiggs was going through recently, and how she felt about it.  Really excellent work.  It also clears up a lot of the mystery about what the last few months of Travis Twiggs' life was like, and reinforces the impression we probably already have, about how the Marines are still quite a bit better at fighting wars than they are at tending to the needs of their warriors, and how Twiggs' guilt over losing several men from his platoon weighed on him heavily, and didn't resolve.  Kellee comes across in a great way, and it's very sad at the end of the tape, when she breaks down talking about how much she misses him.  In the rest of the tape she's very composed, under the circumstances, and makes an impassioned advocate for better psychological care for the troops.  Here's the link to the excellent raw interview footage; if it becomes available as a video to embed, I'll add it here as well.  Great work.  Click here for the link.  (See also this later blog entry, linked here, which includes a transcript of the interview.)

Editor's Note: Elsewhere today we've learned that Kellee and her husband, Travis, go way back: they were childhood neighbors in Louisiana, and had been married for nine years, with two children.  That's another way of saying, she really knows the guy, and what's "normal" or "abnormal" in his behavior.

The Ballad of Travis Twiggs

I'm personally still reeling from the apparent murder-suicide of USMC SSgt. Travis N. Twiggs and his brother, Will Twiggs, as the cops closed in on them in Arizona yesterday.  (See umpteen shallow news reports for the same basic information, but no explanatory context or any insights as to why.)  Our previous blog entries about Travis Twiggs are here, here, here and here.

While I make my feeble attempt to sort through what is known and what is not, and blog about it later, I'm struck by one comment Twiggs made in the essay he published about his own signficant struggles with PTSD.  The comment is specifically about PTSD:

"I pray that no Marine or sailor, or any service member for that matter, ever has to go through what I went through." -- Travis N. Twiggs, RIP, 5/14/2008.

RIP Travis N. Twiggs, USMC PTSD Sufferer

Very sad just breaking news in the USMC Staff Sergeant Travis N. Twiggs story we blogged about yesterday.  See link for details.  It sounds like authorities who were searching for Twiggs and his brother, wanted in an armed carjacking in the Grand Canyon on Monday, learned that they just killed themselves as they were being surrounded by police in Arizona today, in a potential murder-suicide (though no one is speculating who killed whom at this point). The real tragedy that you won't necessarily learn about elsewhere, is that Twiggs, one of the few Marines to come forward and write both convincingly and publicly about his significant struggles with PTSD.  He was the the author of an article called "PTSD: The War Within, A Marine Reflects on His Struggles with PTSD," that was published in the January issue of the Marine Corps Gazette, and noted in an article by Washington Post correspondent and military historian, Tom Ricks. Click here to read a copy of that original article by Twiggs, whose recommendations must now of course be considered in light of his subsequently tragic, self-inflicted death.

While several elements in Twiggs' realistic but optimistic story cast doubt to this writer on whether he'd actually overcome his demons, his words undoubtedly gave hope to many, and provided a flesh and blood example of a combat veteran who truly understood.  It's with great sadness that we note the literal "end" to the Travis Twiggs story.  We hope that the five(!) tours of duty he gave his country as a Marine, first in Afghanistan, and then four more in Iraq, are remembered more than his untimely and tragic end.   And we hope that much greater attention will be paid to the cumulative effects of back-to-back deployments and lifetime total load of triggering exposure to the things that cause PTSD.  RIP, Ssgt. Travis Twiggs.  You gave what you had to give, both before and after combat.  It's just a very sad tale that it had to end this way.

Mark Twain had a famous line about truth needing to be stranger than fiction, because fiction at least needed to observe some sort of structure in order to make sense.  In that light, there's a particularly, to me, poignant end to Twiggs' own article.  He tells his guys -- the ones he knew, and the ones he didn't yet -- "My e-mail is [omitted], and I will help anyone in need."  That's a great, kind statement, and particularly sad in light of the realization that Twiggs himself apparently wasn't able to get all the help he needed, either.

Editor's Note: If you want to learn more about who Travis Twiggs was, go to this longer entry, linked here. 

PTSD - "The War Within" - Claims Another Victim

How quickly, it would seem, one can go from badass to bad apple, when PTSD is involved.  USMC Staff Sergeant Travis N. Twiggs, please, say it ain't so.   I so want to believe this is a case of mistaken identity, or that somehow out there might be several Travis Twiggs, roaming America, with their country music star-sounding names.  But at this particular moment, that just seems more than a tad unlikely.

Some background.  On January 8th and then again last month, on April 23rd, we wrote about Travis Twiggs on this blog.  (See entries here and here.)  Twiggs is/was a USMC staff sergeant, from the 2nd battalion, 6th regiment, company G, who had served four(!) tours of duty, one in Afghanistan, and three in Iraq, including most recently in Fallujah.  That's a photo of him on the left, from about a year ago, touring a plant in North Carolina, and thanking them for sending his guys specialized socks in Iraq (Thor-Lo).  I've cropped the photo but he's talking with a seamstress at the plant, and he presented the company with a flag that was flown in Iraq to thank them for their support.  All good so far.

His story initially came to my attention because Washington Post columnist and well-known military author Tom Ricks wrote about Twiggs briefly in January.  Twiggs has been forthcoming about his battle with PTSD, and has told his story compellingly, most recently in the Marine Corps Gazette, in January of this year, in an article entitled, "PTSD: The War Within.  A Marine writes about his PTSD experience."  I wanted to secure Twiggs' permission to retell his story in full on this blog, in his words, but although he attached his email address to the article, and other email addresses have surfaced, no reply was forthcoming to my email requests.  Nor did the Marine Corps Gazette respond.  This, and some things he said in his article, both gave me pause, and made me wonder -- was his story really such a resounding success after all?

Fast forward to the tragedy part of this.  (If you do a people search for Travis Twiggs, you really only find one, nationally, who's his age, 36, so it seems pretty clear this is one and the same person.  From the photos, you can tell that there's also more than a slight resemblance.)  Today my blog statistics were spiking high and it made me curious to see what search was being run.  Cut to the chase: people were looking for news about Travis Twiggs.  And why?  Well, it turns out he's suspected of carjacking a couple's vehicle in the Grand Canyon, there's a manhunt underway for him and his brother, who's suspected in the same crime, and they're both considered armed and dangerous.  News coverage mentions that he's a ten year military veteran (they don't say he's a Marine), covered with tattoos, who suffers from PTSD and is known to behave erratically.

It is heartbreaking to read this news.  What gave me pause about Twiggs' original story?  Two main things.  He attributed, somewhere I read, a signficant portion of his "cure" to spirituality.  Spirituality, while significant to those who believe in its importance, is really an adjunct to treatment, not the treatment itself.  Seriously.  The other reason was, he credited another significant portion of his improved mental health/recovery essentially to working out.  I left that out of the part I quoted, because it just rang so hollow.  Working out is great.  It's an effective, known way to disperse aggression, create feel-good hormones, and increase positive self-esteem.  But in no way, shape or form is it meant to be a cure for PTSD.  It is, again, a part of an effective personal coping strategy.  These two issues created doubts in my mind; the third doubt was planted by Twiggs and the Marine Corps' completely dead silence in response to requests to reprint his article.  On the off-chance he really was doing well, better than expected (and I very much wanted to believe that), his words could have helped many, many people.  However, the lack of response created an impression that perhaps the recovery was oversold, or somehow premature. If you rave up a cure, but you're really not there yet, you definitely want to distance yourself from those words in print when you later on turn out to be struggling.  Very understandable, if that's the case.

I'm so very sad to learn about this armed carjacking.  I very much hope it's not the same person at all.  And I hold out faint hope that even if it is, that it can still work out "well" -- but who knows what "well" would look like at this point.  Prison doesn't sound like fun OR a cure; or even an effective place to get treated for combat trauma.  Marines are in many ways, the best of the best.  (Marketers sometimes joke that the Marines have one of the strongest "brands" in America.  Truly they do.)  They're amazing warriors, but they also can have a habitual reluctance, borne in part by what they do for a living, so to speak, to admit weakness, when and where it exists.  Twiggs made a mighty attempt to admit the weakness he felt, by publishing that initial article, and by taking the rest of the steps he did, to try to get well.  As we have the opportunity to study the effects of combat on veterans, especially in light of combat trauma and PTSD, it's going to be increasingly important, I believe, to take a look at two things, among others, both of which affect Twiggs' own situation.  How many times you've served (which includes length of deployment and time off in between) -- in Twiggs' case that was four -- and what went on when you were there.  Twiggs was in Fallujah, at least on his last deployment.  What happened to him there, and did anything that happen there have bearing on what happened next?

Come to think of it, right at the beginning of Twiggs' own story, he talks about being sent back into combat after already experiencing too much.  That has shades of the Eric Acevedo story as well.  Heartbreaking.  When will the time come when we care as much for the warriors, like Twiggs, as they have cared for us -- by serving?  Sadly, that question is still rhetorical.  Wherever you are, Travis Twiggs, I hope it goes well with you, as much as it can, under the circumstances.  The responsibility for what you're going through is actually shared.

One Marine Reflects on His Battle with PTSD

Back in January, The Marine Corps Gazette published the account of one Marine's own struggle with PTSD.  The Marine was 1st Staff Sergeant Travis N. Twiggs, and the article was called "PTSD: the War Within - A Marine Writes about His PTSD Experience."  Twiggs had four deployments with OIF/OEF: one to Afghanistan, and three to Iraq.  He writes fairly bluntly about what his experience with PTSD was like; how it crept up on him; what the process of admitting that he had it was like; and what he did to recover from it.  He also writes a postscript about what his like has been since then.  I've tried to contact Twiggs several times and the Marine Corps Gazette, to see about getting permission to reprint Twiggs' story on this blog; but haven't heard anything back.  That makes me concerned that perhaps the end of the story isn't as positive as it seemed it was going to be; but I hope that I'm wrong about that.  Twiggs' writing his story about his own fight with PTSD is a very powerful thing.  While many veterans obviously suffer from PTSD, not many have come forward to really talk about what it's like to have had it, and to have made progress in overcoming it.  That's why Twiggs' story is so valuable.  It also has the added benefit of being a story by a combat veteran to other veterans -- with all the shared camaraderie and empathy that implies. I hope things continue to go well for Twiggs -- his example and his openness can really be helpful to other veterans who are suffering from combat trauma.

Some items that stand out from his story:

• A triggering point: arriving back in the U.S. after his third deployment, and being greeted by the families of the two Marines who were killed in action on his tour at the homecoming for his battalion.  It seems to have pushed to the forefront of his mind the question, "Why them, why not me?" which is classic for people to ask.  "From then on my life began to spiral downward," he says.
• At another point he describes being back from the front: "When I arrived back in the States, it was as though I had never left. All of my symptoms were back, and now I was in the process of destroying my family. This was all taking place because I did not understand what was happening to me. My situation worsened, if you can believe that. I started neglecting my work, and my answer for everything was alcohol."
• In other point, he describes with great poignancy the real battle within himself: "The true horror of war is coming home without all of your Marines, because at some point you have to look at yourself in the mirror and wonder, “Did I give them my all?” “Did I train them to the best of my ability?” I could not answer yes to either question. I still can’t and wonder if I ever will." (That last point also makes me concerned about how fully he's been able to put this in the past; it's probably still far too difficult to - and there's definitely no shame in that.)

Another constructive part of the article is the recommendations he offers as a layman, about what he believes helped his PTSD, and what might help others.  Here are the majority of things he says he learned from the experience, that he can recommend to others:

• Medication alone will not calm PTSD symptoms. Therapy is a must, and it has to be done with others who have experienced the same war or conflict. In other words, veterans of Operation IRAQI FREEDOM should not be undergoing therapy with Vietnam or Operation DESERT STORM veterans. The symptoms are the same, but the time periods are different.
• Alcohol and pills don’t mix. The Marine/sailor should never be told that moderate alcohol consumption is acceptable.
• It is okay to mourn those you’ve lost, but remember, they don’t want you to be sad. They want you to celebrate their lives.
• PTSD is not a weakness. It is a normal reaction to a very violent situation.
• I firmly believe that a lot of my [subsequent] problems were caused by overmedication. The medication affected my judgment and my ability to cope with the true issues that haunted me. I also have since suffered from a seizure, which is believed to have occurred from the same cause. So, ensure that the Marines/sailors know that it is okay to question the amount of medications they are taking and why.
• Place more emphasis on the post-deployment health questionnaire all Marines/sailors have to fill out before leaving theater. I remember Marines being told that if they marked “yes” to anything, it would cause problems with their taking leave. They don’t know that PTSD is not even noticeable until they come home. Marines/ sailors should fill out these questionnaires honestly when they get back in garrison, and they need to know that it is okay if they are experiencing difficulties readjusting.
• Leaders should sit down with their Marines/sailors prior to releasing them for leave and cite different examples of PTSD so that they know what to expect and how to recognize the symptoms. When they return from leave, leaders should get them enrolled in as many schools as they can. Regardless of whether they can get them into the schools or not, leaders should set up a well-planned schedule for them.

Wherever you are, Travis Twiggs, best wishes for your continued health and healing.  Thanks for being strong enough to write this; thanks for sharing it with your fellow combat veterans. 

Editor's Note: A copy of the original article is linked here; a PDF copy of it on the Web is also linked here.

Marines and the Stigma of Mental Health Issues

If you haven't done so already, you owe it to yourself to read the excellent article published recently in The Nation, called "Denial in the Corps."  The author, Kathy Dobie, did another great piece for GQ recently, which we blogged about here.  (That entry was entitled, "Superb Writing about a Vietnam Vet's PTSD and Subsequent Nervous Breakdown.")  Kathy Dobie is a superb writer, who crafts an excellent narrative -- every sentence in the Nation piece is worth reading, and both informs and moves the story along.  Regrettably, the story is a painful one to tell, about how Marines haven't yet fully risen to the challenge of taking care of their own who have been used up, broken down, or shattered into pieces by their experience at war.  Three paragraphs are the sum of the story:

"According to civilian and military defense lawyers, mental health professionals and veterans' advocates, the trajectory of [one of the Marines profiled]'s postdeployment life, with untreated PTSD leading to misconduct and then punishment, is all too common in the Marine Corps. A marine endures one, two, even three tours in Iraq, serves honorably and well, but returns suffering from combat trauma and starts to drink or abuse drugs or becomes violent at home, and suddenly finds himself ostracized, punished and drummed out of the Corps with an other-than-honorable or bad-conduct discharge. A history of service is tarnished, and the marine is denied benefits--even the treatment necessary to recover from combat trauma--and left with only a bitter sense of betrayal. A Corps review in 2007 of 1,019 other-than-honorable discharges issued to combat veterans during the first four years of the Iraq War found that fully a third of the discharged marines had evidence of PTSD or another combat-related mental illness. Lt. Col. Colby Vokey, the Marine Corps's legal defense counsel for the western United States, estimates that of all the Iraq combat veterans his office defends, one-third have PTSD or another combat-stress mental health issue. Many of these clients have served at least two tours in Iraq.

The factors leading to the abandonment of combat-broken marines are both cultural and operational. The Marine Corps is the youngest, most male, most junior and least married of all the services. Sixty-six percent of the troops are 25 or younger; 13 percent are teens; and 39 percent hold the rank of private, private first class or lance corporal. Fewer than 7 percent are female. The Corps's deeply macho culture, which values stoicism in the face of pain and disdains "weakness," makes it hard for marines to seek help. Judith Broder, a civilian psychiatrist who treats Iraq and Afghanistan vets, says, "They all know of stories where buddies have asked for help and have been ridiculed by the chain of command or given some kind of treatment that is not really adequate and told they have to go back."

This harsh culture is exacerbated by the relentless tempo of training and deployment, which pressures commanders to quickly replace broken marines with deployable ones. "You read the Marine Corps values and you'll find that anybody that gets hurt isn't courageous or doesn't have honor," Judith Litzenberger, a civilian defense lawyer and twenty-one-year Navy veteran, explains. "That's how the marines interpret it: 'I went to Iraq and I didn't whine and I didn't claim that I had a mental disorder, and damn well marines don't do that--we suck it up.' And it has to be that way because they have a mission that's bigger than the number of people they have. They can't spend all their time taking care of people who have mental disorders. They've got to wash them out quickly and move on."

There are institutional benefits for washing them out quickly and moving on, and the articles goes on to suggest what those are.  At its most extreme, it's ultimately all about the money.  One retired Air Force colonel, in charge of medical operations in the Air Force's European headquarters, who is quoted in the story, cuts right to the point: "Every kid that gets kicked out with PTSD is gonna be a lifetime of disability payments for the government. Every kid who gives up and kills himself, nothing."

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The trouble is, though, the thing that gets people in this predicament -- PTSD -- is war itself.  Marines and other servicemen and women aren't creating PTSD -- they're developing it, from and in combat.  And combat at a level -- longer tours, more deployments, less time between tours -- that is just unprecendented.  Rather than preparing for the logical outcome of that -- more PTSD cases, a greater need for care -- and PLANNING on and for that -- the tendency seems to be, still to some degree, to blame the participant, and refuse to acknowledge the greater problem -- or the link between the two: combat and PTSD.

A current and disturbing example, surfaced on this blog, is the case of Lance Corporal Eric Acevedo, accused of murdering his former girlfriend in Saginaw, Texas, in what certainly "seems" be a PTSD-related event.  We dug a little bit into his background, and found the extent of the combat he'd seen in the Marines, and what had happened on his tour.  (Read about that here.)  Even found the great, iconic photograph of him, in the Marine's own photo archives, pictured above.  What happened?  WIthin three days, the Marines had removed all trace of Eric Acevedo from their publically-searchable archives.  No photo, no attached story, no reference to the memorial service he attended (where the photo by Heidi Loredo was taken), where ten of his fellow Marines who died in Fallujah were honored.  All references to Lance Corporal Eric Acevedo -- VAPORIZED.  As though he no longer existed; or had in fact, never existed.  What disturbs me the most about this is the simple, brutal fact.  If Lance Corporal Eric Acevedo, a three tour Marine, ended up with PSTD, no matter what he did AFTER he had it -- it's clear where he got it, and how.  For the Marines to distance themselves like that from him goes against all the Three Musketeer-ing sentiment we usually associate: the all for one, and one for all stuff that gets so many guys (and gals) through their unbelievably rigorous training, and in and out of battle.  It creates a terrible impression, too: that while the Marines may be all for one another, on the battlefield, so long as it's a reasonably level playing field; but is the top brass really all for the average Marine?  Only time will tell, but if the Eric Acevedo story is any indication, the perspective is, get in trouble and you're expendable.  In fact, we never knew you.

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The Marine Corps's legal defense counsel for the western United States, Lieutenant Colonel Vokey, quoted in the Nation article says prophetically: "The problem is I don't think the system accounts for these folks with PTSD. There's got to be another way to handle this without lumping them in with every other marine who commits misconduct. They were fine when they went to Iraq, we broke them, this is what combat did to them, and I think we should feel some responsibility for what happens to them." Absolutely; that's EXACTLY the point.

Behind the Bloodshed, Some Backstory

Another day, another lurid headline.  A Marine Lance Corporal in Texas, recently returned from three back-to-back tours of duty in Iraq, and allegedly suffering from PTSD, breaks into his former girlfriend's home, stabs her to death and then waits, "covered with blood and looking dazed," in the parking lot for police to arrive and arrest him.  On the surface, another brutal domestic violence story, with a very tragic ending.  Behind the headlines, though, more questions than answers about troops' after-care, and whether ethnicity (the Marine in question is Hispanic) plays or ought to play a part in how PTSD is diagnosed and treated.

First, some facts.  Marine Lance Corporal Eric R. Acevedo, 22, was arrested over the weekend for allegedly murdering his former live-in girlfriend, in Saginaw, Texas, a suburb of Fort Worth.  The Fort Worth Star-Telegram has been covering the story, and it's typically gruesome, but it's also a tragedy for all concerned. The victim, who was a single mother; the alleged perpetrator, who will likely do substantial prison time; and both people's families -- the 10 year old girl who now grows up motherless, as well as Acevedo's family, who believed he was struggling with PTSD, but was sent back to Iraq.

There are several items that stand out immediately from this story.  One is the obvious: three tours in Iraq by the time you're 22?  Wow.  That's a lot of compressed heavy living right there, at a very young age.  (Acevedo joined the Marines just a few days after graduating from high school.)  Another is obvious from the photos that run with the story.  There's one of Acevedo in his dress blues, looking fit and tanned and what they call in language of the personal ads, "height-weight proportional."  Then there's his booking photo, where he looks, oh, about 44, not 22, and seems heavy, puffy and bloated.  It doesn't even look like the same person.

Then there are the comments from his family, which underscore that to them, Acevedo wasn't the same person anymore.  (Granted, those have to be taken with a grain of salt, because, after all, they're coming his family.  But still, listen to what they have to say.)  The following quotes are from the Star-Telegram.  His aunt: "I know he was a good soldier. I just don't know what happened. When he went in, he was so proud. When he came out, he had so many problems. I don't know what happened to him."  His dad, who feels that his son has never been the same since his second tour of duty in Iraq: "I gave him to the government nice and healthy, and the government returned somebody who is capable of doing something like that...I'm out of words as far as to just how sorry I am."

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In the Marine Corps, Lance Corporal Acevedo did three tours of Iraq over four years' time, returning for the last time 13 months ago, and leaving active service to go into the Individual Ready Reserve.  According to a Marine spokesman quoted in the article, Acevedo had been stationed at Twentynine Palms, California, "and was deployed for about seven months in 2004 and again in 2005-06, and for six months in 2006-07." The Marine spokesman says Acevedo was "a good Marine," and received various medals for his service, including the Marine Corps Good Conduct Medal, Navy and Marine Corps Achievement Medal, Iraq Campaign Medal, Global War on Terrorism Service Medal, Global War on Terrorism Expeditionary Medal, National Defense Medal and Combat Action Ribbon.

But according to at least his parents, something drastic happened to Acevedo between his second and his third tour of duty.  Says his father, "I was very proud of him. He served well over there. He never complained.  But when he did this last tour, he was feeling kind of like he didn't really want to go because of the nightmares and stuff he had had from the second time. My wife tried to stop it over medical issues. They still sent him off."

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Because it's always worthwhile to find out if there's any backstory worth knowing, I did a little digging.   What had Acevedo experienced that might have caused the change in his behavior?  Deep within the archives of the Marine Corps' own website, there's a wonderful, even iconic photo of a grieving Lance Cpl. Acevedo, grasping someone who's identified only as a young relative in an emotion-filled hug.  The occasion is a memorial service to commemorate the 13 lives lost by Acevedo's battalion, 10 of them on a single day in Fallujah, making that one of the largest losses of American life in the Iraq War.  Acevedo served on that tour with the 2nd Battalion, 7th Marine regiment, also known as "the War Dogs."  On December 1, 2005, ten of his brother Marines died in an IED blast while out on patrol.  While all lives lost are precious, and close-knit groups like the Marines feel every loss deeply -- one wonders, is it harder to endure large losses at once, than multiple losses, individually?  Has this even been studied?  (Seemingly not.)  One thing is sure: studies show that the more traumatic incidents a person is exposed to, the greater the likelihood that they will develop PTSD.

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From what his father says, reported by the Fort Worth paper, Lance Cpl. Eric Acevedo wasn't coping so well anymore.  Six months ago, a military doctor "diagnosed his son with post-traumatic stress disorder and placed him on medication that seemed to calm him down."  But there's some dispute about whether those facts were strictly true. The paper also reports that, according to records kept by the Dept. of Veterans Affairs, Acevedo had "not enrolled enrolled in the VA North Texas Health Care System or applied for any VA benefits."  So time will tell which of these stories are true.  But one thing is certain: If Acevedo really did have diagnosed PTSD, at the end of his second tour (after the Fallujah incident), it wasn't a good idea to send him back so quickly for a third deployment, if at all.

And then there are other implications.  The multiple tours and long deployments, with insufficient breaks in between tours, all recent news reports indicate, seem to be wearing troops out, not just the Marines.  (See discussion in today's Military Times.)  Even the Dept. of Veterans Affair's own data shows that when it comes to PTSD (this data is based on Vietnam veterans), "higher levels of war-zone exposure tend... to contribute to a higher degree of symptoms."  (Longer tours and more of them certainly constitute higher levels of war-zone exposure.) 

In addition, the same study showed that "race/ethnicity appeared to be an important risk factor, as African-American and Hispanic Vietnam veterans tended to report more mental health and life adjustment problems. For PTSD in particular, Hispanic male veterans had the highest prevalence rate..."  Not to argue for preferential treatment for various ethnic groups, but, shouldn't the implications of this data at least be acknowledged?  Maybe PTSD is affecting different people differently, even if we don't know all the reasons why yet.  (There are other implications, too, about medications that purport to solve some problems while increasing risks of others; and the jagged line where domestic violence and PTSD can intersect, with often tragic consequences -- but we'll have to save both those discussions for another time.)

Editor's note: The Marine Corps story about the memorial service for Acevedo's battalion is linked here.  The list of Marines who died on 12/1/05, according to Marine Corps sources, are as follows: Staff Sergeant Daniel J. Clay, 27, of Pensacola, Florida; Lance Corporal John M. Holmason, 20, of Suprise, Arizona; Lance Corporal David A. Huhn, 24, of Portland, Michigan; Lance Corporal Adam W. Kaiser, 19, of Naperville, Illinois; Lance Corporal Robert A. Martinez, 20, of Splendora, Texas; Corporal Anthony T. McElveen, 20, of Little Falls, Minnesota; Lance Corporal Scott T. Modeen, 24, of Hennepin, Minnesota; Lance Corporal Andrew G. Patten, 19, of Byron, Illinois; Sergeant Andy A. Stevens, 29, of Tomah, Wisconsin; and Lance Corporal Craig N. Watson, 21, of Union City, Michigan. All 10 Marines died December 1, 2005, from an improvised explosive device while conducting combat operations against enemy forces in Fallujah, Iraq. All 10 Marines were assigned to 2nd Battalion, 7th Marine Regiment, 1st Marine Division, I Marine Expeditionary Force, Twentynine Palms, California; During Operation Iraqi Freedom, their unit was attached to 2nd Marine Division, II Marine Expeditionary Force (Forward).

Commander Beverly Dexter, Military Psychologist

Commander Beverly Dexter, Ph.D., is an Active Duty U.S. Navy Psychologist who has served three tours with Marines in the U.S. and Iraq.  She is a warfare qualified former Navy Special Operations Officer (salvage diver and ship driver) and former Navy Supply Corps Officer.  She completed operational tours on four Navy ships and frequently gives professional military presentations on leadership, resilience building for military families and prevention and treatment of trauma.  CDR Dexter has lived military life as a single person, double active duty couple, "dependent" wife and mom, deployed mom, stationed overseas and deployed to a combat zone.  She is the Founder and Chairman of the EMDR International Association Military Special Interest Group and the ISTSS Military Special Interest Group.  Dr Dexter is a leader in the effort to improve trauma treatment for Active Duty, Reservists, and National Guard returning from combat and for their families, and has considerable experience serving Army National Guard troops in Iraq.  Dr Dexter is EMDRIA Certified in EMDR and a Fellow and on the Speaker’s Bureau of the American Academy of Experts in Traumatic Stress.  Author of the forthcoming book, No More Nightmares:  How to Use Planned Dream Intervention to End Nightmares (scheduled for release in 2008), she has taught her original theory of Planned Dream Intervention to thousands of individuals who have experienced rapid resolution of recurring dreams and nightmares.

One Marine's Slow Realization That He Has PTSD

The Washington Post has a brief article on Sunday by Tom Ricks, about one Marine's return from multiple tours of duty in Afghanistan and Iraq, to find that he has PSTD.  Tom Ricks is famous to many of us as the author of multiple books about being in today's military.  In fact, it's one of his books that inspired Nate Fick to become a Marine -- without which we wouldn't have had the benefit of Fick's excellent book, One Bullet Away: the Making of a Marine Officer.

The Marine Ricks profiles in the short piece is Staff Sgt. Travis Twiggs.  Apparently the full article about Twiggs is available in the January issue of the Marine Corps Gazette.  Ricks writes:

People sometimes talk about the sacrifices made by U.S. troops without grasping just what that means. In the January issue of the Marine Corps Gazette, a Marine infantryman, Staff Sgt. Travis Twiggs, recounts how he slowly came to recognize that he was suffering from post-traumatic stress disorder (PTSD) after serving one tour in Afghanistan and two in Iraq.

While you're visiting the Gazette site, you might want to check out the "Letter on PTSD from MEF Commanding Generals," which we've linked, here.  It wouldn't win any awards for clear, compelling writing -- unlike Ricks' or Fick's -- but it has an interesting graphic at the end, chock full of too much information, which nevertheless calls for PTSD to be treated early, and to be treated like any other injury, without stigma.  That is, if I'm reading the graphic right.  In which case, that's great.

Editor's Note: Tom Ricks is the Washington Post's military correspondent.  He's also the author of Making the Corps (the book that persuaded Nate Fick to become a Marine), and the controversially-titled Fiasco: the American Military Adventure in Iraq.

Rudy Reyes - Serious Veteran Eye Candy

Marine Sergeant (Retired) Rodolfo "Rudy" Reyes -- USMC 1st Recon Iraq war veteran, indisputable eye candy, soon-to-expire-cover pic from the 2007 "American Heroes" calendar from FreedomIsNotFree.org, frequent search term within this site -- we salute you.  It's a belated Veterans' day thing and/or an early birthday present to myself!  Mostly everyone who comes to this site, comes through a link or through a fairly heavy, intellectual, serious search about combat trauma, PTSD, signs and symptoms, treatment protocols that work, etc., etc.  But every once in a while, and not that infrequently, actually, somebody comes who is just looking for pics of Rudy Reyes.  I feel ya.  I can completely understand why.  So in the spirit of honoring yet another veteran who serves the cause, in his own special way, here's not just pics but actual VIDEO about Rudy Reyes, from the Freedom is Not Free website, and check this out -- there's actually some very good points being made about veterans aftercare and its affordability, or lack thereof.  Go, Rudy!

(If you've read Evan Wright's Generation Kill, or Nate Fick's One Bullet Away, both about the platoon in the 1st Reconnaissance battalion in which Fick and Reyes served in Iraq, you've been introduced to Rudy Reyes already.  Here's a pic of Nate Fick and Rudy Reyes from their tour in Iraq with 1st Recon that was on the web a while back, probably from Wright's book.  And here's the cover pic of Rudy Reyes from the current philanthropic calendar for Freedom is Not Free, before it got airbrushed a bit more.   Swoon, faint, thud...).

Editor's Note: Apparently Generation Kill is going to become a 7-part miniseries on HBO, and Rudy Reyes is tapped to play himself.  Hre's the link to the news on HBO (see item from June 1, 2007).

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Update: I recently got a chance to communicate with former First Recon Marine and current international heartthrob, Rudy Reyes, one of the stars of the HBO miniseries about Generation Kill (linked here), and learn what his future plans are -- and they're exciting.  (Searches for Rudy Reyes skyrocketed this week, coming from places as disparate as Jack in the Box and the U.S. Senate, and from Alaska to Argentina.  I joke that everyone but the Pope searched for Rudy Reyes this week, and perhaps even him.  Reyes just got an agent -- William Morris -- (he's gonna need one!) -- there are some stupendous shots of him on the Web -- and there are plans for him to release an undoubtedly hotly-anticipated workout video and more, based on the concept of "Hero Living."  Can't wait to see what that's all about. (My semi-educated guess is his eventual website will be, www.RudyReyes.com, but currently there isn't any content posted there -- so check back periodically to see when it is.)

More Coverage on "New England's Own" Readjusting to Life after Combat

Emily Rooney, from WGBH -- Boston's public television station -- does a great piece interviewing Charles Sennott, from the Boston Globe, who spent a year covering a battalion of Marines' return from Iraq, and Sgt. Mark Wills, one of the Marine reservists, from the same battalion. Both Sennott and Wills are a great interview, and highlight various issues, pro and con, about readjustment issues, including combat trauma; and Rooney does a nice, pleasant, competent job talking to them about their experiences. Excellent, informative stuff about veterans issues -- well worth watching.  Click here for the link.  Click here to read the earlier blog entry that mentions Sennott's excellent, recent series in the Globe, called "A Promise to Keep."  One additionally interesting factoid is that the Marine battalion that Sennott profiles, the 1/25th, is almost entirely made up of reservists, whose issues can be slightly different on returning, because they typically only see each other about once a month, unlike active duty.

(For a multipart series on the same battalion's homecoming and aftermath, focused more on the injury and recovery of Cpl. Patrick Murray, see the series in the Providence Journal-Bulletin, linked here.  That includes video as well.)

If you want to see the other excellent videos from the Sennott series in the Globe, "A Promise to Keep," including "Coming Home," "The Roulette Wheel of Death," and "Moving On," check out the earlier blog entry, linked here.  Kudos to the Boston Globe for giving Charles Sennott a year to follow this story and do it justice, and to Emily Rooney, for doing a great job, too, highlighting the work in a much shorter amount of time.

The Sacred Brotherhood of Veterans

This is a post I've been meaning to write for a while - because the incident that spurs it, while still a few weeks old, didn't get nearly the coverage that it could have, so it's still going to count as "news."

It seems clear that if returning combat veterans end up getting better treatment (and hmmmn, we're still waiting for that) these days, from the VA and from society at large, it will in large part be because of what earlier veterans -- in particular, Vietnam veterans -- experienced.  The Vietnam vets' unfortunately "bad" experience will somehow work to create a noticeably "better" experience for current combat veterans.  At least, that's the hope.  And not just ours, but many Vietnam veterans as well, who frankly have suffered enough, and if there's any benefit to their suffering whatsoever, want to see that it means the next generation might suffer a little bit less, in trying to uncoil themselves from combat and readjust to civilian life.  When I think of this phenomenon, I really do picture a bridge, or chain of arms -- from one part of the sacred brotherhood of combat vets to another -- reaching out, to make sure that they make their way across what can be very troubled waters.  Of course now the "sacred brotherhood" also includes women veterans as well, but rather than get lost in some murky, cumbersome language, let's just call it the brotherhood and realize it includes women vets as well.  Whoever's been through combat, innately understands what it took to live that experience, and instinctively can help others going through that, and ideally help them come to terms with their loss.

The point of bringing this up -- the focal point of this post -- is to introduce one great example of a  Vietnam veteran who, despite his rank, really didn't "forget" what it was like to go through combat, no matter how many years ago.  When General Peter Pace stepped down in early October as the Chairman of the Joint Chiefs of Staff, he apparently went straight from his good-bye ceremony to the Vietnam Wall.  And at the Vietnam Wall, to the shock and surprise of many onlookers, who came across these tokens over the next few weeks, he left three index cards, laid against the wall.  With his four stars rank pinned to each of them, and a handwritten note to each of the three buddies he'd lost, in the Vietnam War.  The notes each said something like, "These are yours, not mine! With love and respect, your platoon leader, Peter Pace"

Here's a couple of photos of General Pace's mementos, close-up and in place; and a link to a video at CNN, describing what happened.  Props to blogger Old Sarge for pointing this out, and giving us permission to republish the photos.  For a link to the Wikipedia entry on General Peter Pace, click here.

Nate Fick's Inspirational Stance on Veterans Care

Last year around this time I had the pleasure of meeting Nathaniel Fick, author of the stupendous One Bullet Away: the Making of a Marine Officer.  (Here he is at the Marine Ball at the Harvard Business School, where he is an MBA candidate, signing a few copies of his book.)  Whenever I think of combat trauma, I think of how inspirational Fick's own words on the subject were.  Writing in an article in the Boston Globe from August 28, 2005, entitled, "Coming Home...to What?" Fick wrote about the need to take veterans' psychological health seriously on their return from combat, possibly even mandating screening for combat trauma/PTSD.  Said Fick at the time:

The screenings are only one step in the long process of reintegrating combat veterans, but mandating them would correct a dangerous oversight and better serve both veterans and the communities where they live. To have value, though, the screenings must be done right.  Members of the active-duty forces are already subject to post-deployment mental evaluation, as are the National Guards of several states. These screenings often involve little more than filling out forms.

I remember slogging through my own mental health questionnaire after leaving Iraq, answering questions such as ''Did you ever feel that your life was in imminent danger?" Yes.  Or ''Check all that apply: I saw the dead bodies of a) enemy combatants; b) American forces; c) civilians; d) all of the above." D.

Answers like mine should have prompted some sort of follow-up, but none came.

Psychological screenings in a vacuum are worse than a waste of time because they give a false sense that someone has been ''cleared." The main lesson of my experience is that the recovery process takes time, and healing only happens in community. Screenings can be gateways to those communities, both formal ones such as therapy groups and counseling sessions, and the informal networks of friends, neighbors, and colleagues with whom we live.

In a war whose burden is borne almost exclusively by the tiny minority in uniform and their families, veterans' care is one place we can all make a difference."

Nate Fick's book, One Bullet Away: the Making of a Marine Officer, is well worth reading, as is the rest of his writing.  But most of all, I appreciate his inspirational stance on veterans issues -- that taking care of veterans really is the second half of the social contract, if the first half is sending them off to war on our behalf.

Into the (Mental Health) Gap - Military Chaplains and Others

I was hunting around on the Web tonight for material for a different post entirely -- one about the rumor that military chaplains are being pressed into service as stop-gap mental health counselors -- and whether this is a good, albeit temporary solution -- or an overly simplistic band-aid with unforeseen complications -- when I came across this news item instead.  It's a pretty good wrap-up, from a good reporter at the Air Force Times, Karen Jowers, about some solutions the military, particularly the Air Force, is offering its servicemembers to cope with combat trauma, PTSD, and long deployments.  The article is worth reading, and is linked here.

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As far as the chaplain topic goes, which I wasn't able to find enough information about to verify that it is indeed contemplated, here are some off the cuff thoughts.  One is, and probably paramount, anything is better than nothing, if it goes to the good of the afflicted servicemember.  If there's too long a wait at the VA to see somebody, provided that the chaplain is generally qualified and perhaps even recently trained in PTSD and related issues, far better to see someone, quickly, than no one, or to have an unduly long wait.  It sounds like too many people can't endure the wait, when they've got troubling topics on their minds.

That said, let's hope that's not being proposed as anything other than a stop-gap solution, while the VA fixes the problem it has of too much demand and too little supply (qualified counselors, able to make appointments with veterans.)  I only know anecdotally of three different chaplains in the military lately, and the stories are mixed.  Story #1, referenced earlier in a blog entry here, is about a chaplain who himself suffered PTSD after being deployed to Iraq, then was sent to Hurricane Katrina while he was still affected, and though he was a middle-aged man with a wife and family, was so stressed out by the experience that he is now divorced and homeless.  That's not a good story, but it was told to me by the mother of an Army soldier who committed suicide after coming back from Iraq, and ironically, it was the chaplain who had been a source of support for him earlier; until the chaplain's own exposure caused troubles larger than what he could handle.  That's Story #1 that I know about, and it's negative.   

Story #2 is the cheery-seeming, snappy-sounding, highly quotable, funny and cool chaplain from the Minnesota National Guard, who's quoted in so many of the NPR stories from 2006.  (References to Chaplain John Morris of the Minnesota National Guard on this blog are here, here, here, and possibly here, not to mention, most recently, here.) He sounds generally delightful, sane and grounded -- and really an asset to those he's around.  That's Story #2, and it's uniformly positive. We don't know the man personally, of course, but he's made a great impression on us, and, it would seem, on NPR as well.

Story #3 I was exposed to the other night, when I was chasing down more information on the Web  about  the wonderful Maxine Hong Kingston and the book she edited, Veterans of War, Veterans of Peace.  I was able to see her and a panel of combat veterans and interested others, whose pieces make up that book, in Santa Rosa, CA recently, and wrote about it on this blog.  I've also watched the Bill Moyers special that aired over Memorial Day weekend last year about her book, which covered a few of the participants as well.  There are only two videos I've found on the Web that relate to Maxine Hong Kingston and her work with the veterans' writing project, and recently I watched both of them.  They're located here and here.  In the second one, one of the panelists at the talk at the Commonwealth Club in San Francisco, in April of this year, is a young Marine named Jim Castellanos, who tells a quite cautionary tale of turning into a conscientious objector as a Marine, and more particularly, for the purposes of this blog entry, about being what amounts to "blamed and shamed" by the chaplain he's required to see, which only serves to further burden the already conscience-stricken young man.  (If you want to watch the video, it's embedded below, and Castellanos starts telling his story at about the half hour point into the video -- minute 30 or so.)  (See Wikipedia, linked here, for a definition and background of what a conscientious objector is, a term familiar to many of us from the Vietnam War.)

Again, the focus of this blog is apolitical, so including this story isn't to be pro-war or anti-war or anything but pro-veteran.  However, his story is pretty troubling, in terms of the communication he had with the chaplain assigned to him.  It sounds like the chaplain was a South Vietnamese guy who had immigrated to the U.S., joined the military, and been deployed several times with the Marines.  Perhaps his OWN experience of living in war-torn Vietnam as a maturing adult contributes heavily to his own bias, but he appears to not be aware of this bias when he is "counseling" Castellanos. 

The synopsis of the story is that Castellanos, who had joined the Marines at 17 in high school, later had a change of heart -- perhaps due to the maturing process, perhaps due to reading more philosophical texts in college, whatever -- and decides that he's really not cut out to be in the military after all -- doesn't want to carry a gun and doesn't want to kill people, for any reason -- in other words, pretty much the poster boy for a well-reasoned, Conscientious Objector -- the chaplain he meets with is someone it's hard to picture has ANY people skills or therapeutic counseling skills.  Castellanos tells the story from his own perspective, of course, but it sounds like the chaplain was pretty harsh with him -- and really taunted him, in a fairly unprofessional way -- about his ideology, to the point that Castellanos apparently felt worse off from meeting with him, than if he never had had the conversation. 

Later, he's able to meet a more reasonable person and talk to him about his feelings -- not that the Marines ever ultimately accept his plea to become a Conscientious Objector -- but to say that the first chaplain "got all up in his grill" is pretty descriptive.  Castellanos was already troubled about his decision, just based on internal pressures he was feeling, and the chaplain did nothing but mock him and essentially increase the external pressures.  Someone like this isn't someone you'd really like to see doling out any pastoral care to troops with sensitive issues and psychological pain.  Don't take my word for it, watch the video, and hear it from Castellanos himself.  So that's Story #3, and the chaplain was very destructive, and insensitive to the point of being actually harmful.  So out of three stories: that's one positive and two negative.  Granted it's a small sample but it's not filling me with confidence on the topic as a whole.  What I'd like to see, and what I'm sure a lot of us would like to see, is the VA just stepping up to deliver the care that's needed, with qualified counselors and speedy wait times for veterans.  Stop-gap measures probably shouldn't be anything but the most temporary solution.  That said, if it brings any veterans needed relief in the meantime, while the system is being fixed, more power to 'em.

Marines Teach Combat Stress Prevention at Camp Pendleton

There's a good article from last month's San Diego's Union-Leader about a class being taught at the USMC base, Camp Pendleton, about combat stress -- what it is, and how to recognize its effects.  The class is being taught to corporals, junior leaders who are just starting their ascent through the Corps, about what to expect on the battlefield.  (Click here for the link.) 

One quote from the article, referencing Cmdr. Paul Hammer, a Marine psychologist who's served in Iraq, and was teaching the class in question.  "The Marine Corps tries to fully prepare its troops for war, Hammer said, but some things just cannot be replicated, including the trauma of seeing people being maimed or killed. “You are going to experience some intense emotions in combat. A true leader is one who can truly tolerate the truth of war, and the truth is ugly,” he said. “What we want is for you to bend,” Hammer added, “but everyone has a point at which they will break.” 

Kudos to the Marine Corps for teaching something about combat trauma, before it happens, and removing some of the stigma of talking about it.

Today's Vets Owe Debt of Thanks to Vietnam Vets

Another interesting article that was circulated widely on the Web a while back is this seemingly open letter to veterans from a Marine office reservist serving in Iraq.  The letter was allegedly first published in the Veteran of Foreign Wars publication, "Reveille," and was written by USMC Major (now retired) Brian P. Bresnahan.

Biographical note: Brian P. Bresnahan is a 1992 graduate of UNL and a (retired) major in the United States Marine Corps Reserve who lives near Benedict, Nebraska. A veteran of Operation Iraqi Freedom, Maj. Bresnahan was stationed eight miles west of Fallujah during 2004.  He writes in his letter:

"A guy gets time to think over here and I was thinking about all the support we get from home. Sometimes it's overwhelming. We get care packages at times faster than we can use them. There are boxes and boxes of toiletries and snacks lining the center of every tent; the generosity has been amazing. So, I was pondering the question: "Why do we have so much support?"

In my opinion, it came down to one thing: Vietnam. I think we learned a lesson, as a nation, that no matter what, you have to support the troops who are on the line, who are risking everything. We treated them so poorly back then. When they returned was even worse. The stories are nightmarish of what our returning warriors were subjected to. It is a national scar, a blemish on our country, an embarrassment to all of us.

After Vietnam, it had time to sink in. The guilt in our collective consciousness grew. It shamed us. However, we learned from our mistake. Somewhere during the late 1970's and into the 80's, we realized that we can't treat our warriors that way. So, starting during the Gulf War, when the first real opportunity arose to stand up and support the troops, we did. We did it to support our friends and family going off to war. But we also did it to right the wrongs from the Vietnam era. We treated our troops like the heroes they were, acknowledged and celebrated their sacrifice, and rejoiced at their homecoming instead of spitting on them.

And that support continues today for those of us in Iraq. Our country knows that it must support us and it does. The lesson was learned in Vietnam and we are better because of it.

Everyone who has gone before is a hero. They are celebrated in my heart. I think admirably of all those who have gone before me. From those who fought to establish this country in the late 1770's to those I serve with here in Iraq. They have all sacrificed to ensure our freedom.

But when I get back, I'm going to make it a personal mission to specifically thank every Vietnam Vet I encounter for their sacrifice. Because if nothing else good came from that terrible war, one thing did. It was the lesson learned on how we treat our warriors. We as a country learned from our mistake and now treat our warriors as heroes, as we should. I am the beneficiary of their sacrifice. Not only for the freedom they, like veterans from other wars, ensured, but for how well our country now treats my fellow Marines and I. We are the beneficiaries of their sacrifice.

Semper Fidelis,
Major Brian P. Bresnahan
United States Marine Corps

Three Gifts You Can Give Returning Veterans That Will Last a Lifetime

Three gifts that you can give returning veterans that will last them a lifetime, so says USMC Brigadier General Timothy C. Hanifen, 2nd Marine Aircraft Wing (Forward), are the following: "understanding," "support," and "affirmation."

Writes Hanifen:

The combat phase of the campaign in Iraq is winding down [this was first published in February of 2006] and now the hardest job of all begins-winning the peace. Soon many of our fellow citizen-Soldiers, Airmen, Sailors, Marines and Coast Guardsman-both active and reserve will return home with their units or as individuals. All have served and participated in an extraordinary campaign of liberation that was fought in a manner that reflected not only the determination of the American people to do what was necessary but also reflective of our value to spare life whenever and wherever possible.

As these veterans begin returning home and people are asking themselves what they can do to celebrate their return, honor their service and remember those that have fallen in the performance of their duty. After every war or major conflict, there are always concerns about the emotional state of returning veterans, their ability to readjust to peaceful pursuits and their reintegration into American society. People naturally ask themselves "what can we do or what should we do?" The purpose of this message is to offer that there are three very important gifts that we personally and collectively as a society, can give to these returning veterans. They are "understanding, affirmation and support".

With "understanding", I am not speaking of sympathy, empathy, consoling or emotional analysis.  Rather, I offer that we, to the best of our ability, need to comprehend some of the combat truths learned and experienced by these returning servicemen and women. Their perspectives and their personal experiences will shape each of them and our society in large and small ways for years to come. Though we were not there, our comprehension and respect for their "truisms" will be part of the gift that will truly last them and us for a lifetime.

The truth every combat veteran knows, regardless of conflict, is that war is about combat, combat is about fighting, fighting is about killing and killing is a traumatic personal experience for those who fight. Killing another person even in combat, is difficult as it is fundamentally against our nature and the innate guiding moral compass within most human beings. The frequency of direct combat and the relative distance between combatants is also directly proportional to the level of combat stress experienced by the surviving veteran. Whether the serviceman or woman actually pulled the trigger, dropped a bomb or simply supported those who have, I've yet to meet any veteran who has fought and found their contribution to or the personal act of killing another human being particularly glorious. Necessary-Yes. Glorious or pleasurable-No. In combat, the veteran must psychologically distance themselves from the humanity of their opponent during the fight. The adversary becomes a target or an objective or any number of derogatory epithets that separates "them from us". Combat becomes merely business-a job that has to be done, part of your duty and killing-a necessary result. It's a team job that needs to be done quickly, efficiently, unemotionally and at the least cost in lives to your unit, to innocents and with the most damage inflicted in the least time to your adversaries. Then you and the team move forward again to the next danger area and fight. The only sure way home is by fighting through your opponents as quickly and efficiently as possible. Along the way you quietly hope or pray that your actions will: be successful; not cause the loss of a comrade; the death of an innocent; or that you'll become one of the unlucky casualties yourself. You stay despite your fears because the team-your new family of brothers or sisters, truly needs you and you'd rather die than let them down. You live in the moment, slowly realize your own mortality and also your steadily rising desire to cling to and fight hard for every second of it. You keep your focus, your "game face" on and you don't allow yourself the luxury of "too much reflection" or a moment's "day dreaming" about home, loved ones, the future or your return. You privately fear that such a moment of inattention may be your or worse, because of you, a comrade's last.

So if I may caution, please don't walk up to a combat veteran and ask him or her if they "killed" anyone or attempt well meaning "pop" psychoanalysis. These often-made communication attempts are awkward and show a lack of understanding and comprehension of the veteran. They also reveal much about the person who attempts either one. Instead, please accept there is a deep contextual gap between you both because you were not there. This chasm is very difficult to bridge when veterans attempt to relate their personal war experiences. Actual combat veterans are the one's least likely to answer the question or discuss the details of their experiences with relative strangers. Most likely they will ignore you and feel as though they were truly "pilgrims" in a strange land instead of honored and appreciated members of our Republic. So accept and don't press. One note of personal caution for your awareness- If a combat veteran does answer or appear to openly revel in the number of adversaries they've personally slain then they either haven't or they are likely part of society's 2% sociopaths. In either case, I would recommend you beware and quietly distance yourself. Their enthusiasm and behavior are not normal for a true combat veteran. But here is what you can do. Don't ignore them or the subject. Please feel free to express your "gladness at their safe return" and ask them "how it went or what was it like?" These questions are open-ended and show both your interest and concern. They also allow the veteran to share what they can or want. In most cases, the open door will enable them to share stories of close friends, teammates or some humorous moments of which they recall. Again, just ask, accept but don't dig or press.

The second gift is "affirmation". Whether you were personally in favor of the war or against it no longer matters at this point. As a Republic and a people we debated, we decided and then we mustered the political and societal willpower to send these brave young men and women into combat in hopes of eventually creating a better peace for ourselves, for the Iraqi people and for an entire region of the world. More than anything else, the greatest gift you can personally give a returning veteran is a sincere handshake and words from you that "they did the right thing, they did what we asked them to do and that you are proud of them". We need to say these words often and the returning combat veteran truly needs these reassurances. Also please fly your flag and consider attending one or more public events with your families as a visible sign of your support and thanks. Nothing speaks louder to a returning veteran than the physical presence of entire families. Those Americans attending these events give one of their most precious gifts-their personal time. Numbers matter. Personal and family presence silently speaks volumes of affirmation to those you wish to honor.

The third gift is "support". Immediately upon return there will be weeks of ceremonies and public praise applauding the achievements of the returning units and their veterans. But the pace of life in America is fast and it will necessarily move rapidly onward towards the next event. Here is where your support is most needed to sustain the returning veteran and you can make the most difference in their lives for years to come. Continue to fly your flag. If you are an employer, then simply do your best to hire a veteran who is leaving service or if he or she was a Guardsman or Reservist, welcome them back to a new job within the company. All reserve personnel know that the economic life of the company has continued in their absence. It has to do so in order for the company to survive and prosper. They also know it is likely their jobs have since been filled. Returning veterans are always unsure whether or not they will find or have employment upon return. As an employer, if you can't give them an equivalent job because of downsizing then extend them with your company for three to four months so they can properly job hunt. Please take a personal interest in them and their families and use your extensive list of personal and professional contacts to help them land a better job-even if it is with one of your competitors. The gratitude they will feel for you, your personal actions and your company is beyond words.

For everyone else, the greatest gift you can give to continue support will take 10 seconds of your time. In the years to come, if ever your paths cross with one of the hundreds of thousands of veterans of this or any other conflict, then simply shake their hand and tell them "thanks" and that "they did a great job!" Your words show you understand, you affirm their service and you continue to support them. Teach your children to do the same by your strong example. Though veterans may not express it, every one of them will be grateful. If this message rings true with you, then let us each give these returning veterans these three gifts that will truly last them a lifetime.

(This article has been published in a number of places on the Web, but I first ran across it in a posting on MarineParents.com, from 2/24/2006.)

Marine Parents Conference This Weekend in Houston, TX

MarineParents.com is sponsoring their 7th annual conference this weekend at the Crowne Plaza hotel in downtown Houston, TX.  They have a superb lineup of speakers, not a few of whom should be able to speak about the topic of combat trauma, including Nate Fick, author of "One Bullet Away: The Making of a Marine Officer" (see sidebar), Bridget C. Cantrell, Ph.D., author of "Down Range: to Iraq and Back," (see sidebar) and Michael M. Phillips, embedded Wall Street Journal reporter and author of "The Gift of Valor" (see sidebar).  Not having seen the actual schedule, it's impossible to predict whether anyone's speaking on the exact topic of healing combat trauma; but it's likely that many will be alluding to the experience of combat trauma in their speeches and side discussions.  If we get a copy of the schedule from this outstanding-looking conference, we'll be sure to update the blog with more detailed information.

It's very impressive that Tracy Della Vecchia, a Marine mom, set up MarineParents.com, a highly comprehensive website, originally out of her own love and concern and as an effort to communicate with and support one of her deployed Marine sons.  As she worked on the original site, she found out how important and necessary getting information out was to other mothers like her.  Today, the enormous and impressive, volunteer-staffed site, which seems in its way as big as forums on CompuServe were in their day, is a true testament to the other power of one person wanting to get something done that would help others.  Many, many parents and other family members today of deployed Marines are probably very and rightly thankful to Ms. Della Vecchia and her far-sighted, far-reaching work on that site.

PTSD Veteran on Trial

This coming week -- Thursday, to be precise -- decorated Iraq war veteran Daniel Cotnoir, who served under grueling conditions that few of us can even imagine, doing mortuary detail in the war, goes on trial in Massachusetts for actions that aren't hard to see as a result of extreme combat-related stress.  It will be "interesting" to see how his case turns out, from a legal point of view, but from a humane point of view, only interesting if Cotnoir is treated with compassion and concern, and routed in the direction of further help that's needed, not jailtime which leaves the problem intact.  In honor of the upcoming court case, which frankly unsettles us to think it's even going forward, here's a link to one of the more short 'n factual pieces in the news media about Cotnoir's actions, published shortly after he was arrested last summer.  The article is entitled, "Hero Marine Returns Fire."  Another newspaper column, also published contemporaneously, did a marvellous job of painting a picture of what Cotnoir must have been exposed to, versus the unforgiving nature of society once he returned.  This one has a great, and poignant though accurate, title: "Marine bears up under Iraq's horrors, but cracks at home."  Both are worth a read.  Praying readers may be tempted to throw a prayer or two heavenward on Cotnoir's behalf, as well.  It probably wouldn't be a bad idea whatsoever.

A Wounded Warrior Speaks

The L.A. Times recently carried an Op-Ed piece from Lt. Col. Timothy Maxwell, a severely injured Marine who wanted to speak out about his experience of going, as he put it, from the "A Team" (before injury) to the "B Team" (after injury).  Frequently in this war we hear of people who in a previous war might have died, their injuries were so severe; but thanks to their stronger, protective armor, or faster battlefield care, or any combination of that and sheer luck, some wounded manage to survive what otherwise would have been certain death.  Lt. Col. Maxwell is one such person.  HIs injuries were devastating; and his aggressive stance, post-injury, to do whatever takes to get back to health is impressive and laudable.  But even with the phenomenal focus, willpower and drive he brings to the situation, Maxwell has to admit, it's no easy job being injured, or coping with the feelings of failure and frustration that arise when a great deal of your career self-esteem is tied up in your physicality and ability to perform.  Since no one can do a better job capturing that sense than someone actually going through it, Maxwell's op-ed article is well worth reading.  It's also great to see that in Maxwell's future plans are caring directly for other injured military, and making sure they and their families get what they need to survive what can be a very long, very tiring battle of its own: the battle back to health and wholeness.  Read Maxwell's piece - it's highly recommended.  And he pulls no punches about what an easy task getting well is going to be, for him or any of the other injured.

Legal Woes of Combat Vets

Besides being the official First Day of Spring, today is also an inauspicious date - it's 30 days until the anticipated trial of decorated Iraq war veteran, Daniel B. Cotnoir, in Lawrence, Massachusetts.  Cotnoir, the Marine Corps' 2005 "Marine of the Year," was indicted last month by a Massachusetts grand jury on charges stemming from a shooting in which he participated in August, 2005, which seems (to the outside observer) to have been a clear case of PTSD.  Unfortunately, the Essex County district attorney does not seem to agree, and it looks like Cotnoir will stand trial for his actions next month in a Massachusetts courtroom.

In future posts we will list some of the better recaps available about Cotnoir's difficulties, as well as a look at his quite heroic "before" picture, when he served in Iraq with the Marine mortuary service - a grimmer, more horrific job one is unlikely to find, and one with Cotnoir discharged with great dignity and compassion.  Sadly, Cotnoir is not only Iraq war veteran who's been experiencing legal woes arguably linked to PTSD from his combat experience.  The "Marlboro Marine" - you may remember his photo -- grimy, sweat-streaked face, cigarette gripped in mouth -- is someone else who's wound up on the wrong side of the law after experiencing a fair amount of stressful readjustment to civilian life -- he was diverted by the military to swabbing up after Hurricane Katrina while in the throes of dealing with his own bout of PTSD.

In addition to the substantial physiological and psychological trauma that combat veterans can experience, more than a few will doubtless experience run-ins with the judicial system that they are under-equipped to handle.  Few if any resources seem to be available for supporting the legal woes of combat veterans that may be directly related to the combat trauma they've experienced.  And few lawyers seem particularly aware of or experienced with the special difficulties these clients have faced.  As time goes on, no doubt the situation may improve, but for right now, these veterans may almost be the "test cases" for how the judicial system will handle returning vets whose crimes may turn out to be linked to what they've experienced as a result of combat.

Suffering in Community

Reading the excellent book, The Gift of Valor, by Michael M. Phillips, it's hard not to be struck by what really is a side point in the book: the writer's depictions of the emotional hardship the medical personnel go through at the various trauma stations the wounded from the Iraq war go through on their way back to the United States.  No matter where the medical personnel are located, in aid stations in Iraq, at Landstuhl in Germany, even back in the U.S., or who they are, it seems they're generally unprepared for the sheer level of trauma they're encountering, and what it's going to feel like emotionally to see and treat one after another badly injured veteran.  Many of these doctors and nurses who deliver exceptional care under the circumstances, worked in fairly unrelated roles before -- dentistry, psychology, pediatric and ob/gyn specialties -- that while providing them with a medical background really didn't give them exposure to the types of injuries and hardships they're experiencing day after day in the current war.  In some of Phillips' descriptions, you see the doctors and nurses clamming up or turning away or crying profusely, because it's hard to control their emotions, under the circumstances.  Very understandably, naturally.

An excellent article in a recent issue of the Wall Street Journal (coincidentally, the newspaper where Phillips is a staff reporter), by Sue Diaz, a freelance writer who's also the mother of a soldier in Iraq, makes a similar point.  The hardships of war -- including its searing trauma --  are borne by and endured and affect, not just by those who go, but also by those who are in their immediate circle of community.  As Diaz writes:

"My son has learned much about life the hard way lately. But it seems to me there’s something he doesn’t as yet completely comprehend or perhaps has come to understand far too well. It is this: When he and his men are out on a mission, they are not alone. Whether we agree with this war or not, those of us who love them are out there, too, moms and dads, kids and cousins, sisters and brothers, neighbors and friends.

"Every time an insurgent bomb blows apart a Humvee or a squad on foot patrol, the shock waves from the blast reverberate in small towns like Wheeler, Texas, and big cities like San Diego. A young private takes a bullet; back at home his father’s heart bleeds. A soldier loses a leg; his wife struggles in the days that follow to simply keep putting one foot in front of the other. A sergeant’s eardrum is perforated; his mother hears the explosion in her dreams, time and time again. Truth is, the casualties of war go far beyond the numbers from the Pentagon. Love gives us no choice."

Michael Fay, Combat Artist

It was nice to see the article in this Tuesday's Wall Street Journal, page B1, by author Michael Phillips, himself the author of The Gift of Valor: A War Story, about Michael Fay, USMC combat artist, recently returned from a tour of duty in Iraq.  Combat art is a long tradition that goes back hundreds of years in the military, and some of the best American artists have participated -- names we all know.  Michael Fay's work, which is stunning, can be viewed on his blog, and also at the Navy Museum in Washington, D.C., currently.  (Fay's work will also be featured at the James A. Michener Museum in Doylestown, Pennsylvana.)  It'd be interesting to know from Warrant Officer Fay how therapeutic for him doing art in a combat zone was, or is; it definitely sounds from what he's written that his presence there, with the troops as one of them, doing art about what they were jointly going through, was somewhat therapeutic for others to experience.  There are some incredible pictures on his blog (the Marine Corps owns his work, not Fay himself) of faces of some current warriors, which provide a great window into the stress and exhaustion of combat for the participants.  Be sure to give Fay's work a look -- there's nothing quite like it. (For a look at the combat art from previous generations, be sure to check out this link.)